Tuesday, September 29, 2009

Why the Public Option Is Central to Health Care Reform

Imagine your ideal health insurance plan. First of all, it’s there when you need it; so when you get sick, you get care. It can’t be cancelled because of a loophole. It allows you to make your own health care decisions with consultation from your doctor and no interference from insurance company bureaucrats. It won’t discriminate against you because of gender or a preexisting condition. It’s affordable, which means no exorbitant out-of-pocket expenses, deductibles or co-pays. There’s also no arbitrary cap on how much care you can get over your lifetime or in any given year. It doesn’t disappear if you lose your job and it doesn’t change if you change jobs. And it fully covers all check-ups and tests that helps you avoid getting sick in the fist place.

The Medicare-like public insurance plan included in the bill that has passed four out of five congressional committees and the health care agenda that President Obama campaigned on last fall fits the ideal health insurance plan I described in the previous paragraph exactly. That’s what the public option actually is. It doesn’t discriminate because of preexisting conditions, it doesn’t allow insurance company bureaucrats get between you and your doctor and it’s always going to be there when you need it. Because it isn’t based on profit, there is no reason for it to deny you care when you get sick. And it would actually reduce the federal budget deficit by billions of dollars each year.

This is the argument that the White House and Congressional Democrats should have been making for the last six months. Instead, they broke the health care reform plan that they proposed into little pieces that don’t make sense on their own. They confused ordinary folks by talking about ten different things in isolation instead of one thing that almost anyone could support. If they had argued for the ideal health insurance plan that provides security and peace of mind for individuals and families alike, they would have naturally made Jacob Hacker’s great idea for a Medicare-like public plan that would compete with private insurance into the centerpiece of health care reform. And this argument would have been far less confusing and far more successful.

In addition, they used a term (‘public option’) that only wonks could love to describe the best idea in their reform proposal. Whether they had called it the American health plan that guarantees care for all Americans as George Lakoff has proposed or Health Plan USA as Senator Chuck Schumer suggested back in May or Medicare Part E (the ‘e’ stands for ‘everyone’) as Mark Kleiman recently mused, nearly any of the alternative names I’ve heard would have been better than ‘public option.’ As a term, public option doesn’t make sense. It doesn’t even sound like it has anything to do with health care or insurance. If you asked most of the people you know who voted for Barack Obama but who aren’t also political junkies what the ‘public option’ is, they probably couldn’t tell you. What’s more, if you explained the public option to them and then asked them about the public option again in a few weeks, they probably won’t remember what it is.

Medicare Part E for everyone explains itself. An American health plan or Health Plan USA are practically impervious to effective political attacks and they accurately describe the simple but easy to support nature of what the so-called ‘public option’ actually is. And while it’s too late to fix this problem now, we can learn from it. From this moment forward, banish the term “two-thirds rule” from your vocabulary. Call it “minority rule” or anything that conveys what it actually means rather than some code that only wonks and political junkies can understand.

Finally, I want to note that a health care reform plan that doesn’t include a Medicare-like insurance plan (NOT a ‘co-op’) to compete with private insurance plans might still make life better and health care more secure more hundreds of millions of Americans. I am fully aware that I am lucky to have the luxury of secure health insurance right now and so I can think about this in relatively abstract terms. But while health care reform without something along the lines of Medicare Part E for everyone may still be able to make the health care system in this country a lot better, it will also signal two things. First, Democrats in Washington still do not know how to talk about policy in a comprehensible way. Second, Democrats in Washington (including those in the White House) are beholden to the insurance and pharmaceutical lobbies to a degree that should be disturbing to anyone who put time and money into electing them last fall.